Livers · Published 2026-07-10 · DOI 10.3390/livers6040067
Rebecca Panconesi, Sangeeta Satish, Chase J. Wehrle, Mingyi Zhang, Keyue Sun, Chunbao Jiao, Omer F. Karakaya, Geofia Crasta, F. Selin Yildirim, Hiroshi Horie, Koki Takase, Nasim Eshraghi, Khaled Ali, Tobias Diwan, Qiang Liu, Yuki Miyazaki, Beatrice Cazzaniga, Jamak Modaresi Esfeh, David C. H. Kwon, Federico Aucejo, Mazhar Khalil, Alejandro Pita, JaeKeun Kim, Robert L. Fairchild, Masato Fujiki, Antonio D. Pinna, Charles Miller, Koji Hashimoto, Andrea Schlegel
<b>Background/Objectives</b>: The use of extended-criteria donors (ECDs) is rapidly increasing, with higher risks for impaired outcomes after liver transplantation (LT). Normothermic machine perfusion (NMP) can enhance graft viability assessment, though lactate clearance as a viability marker lacks consensus in clinical practice. <b>Methods</b>: This study analyzed 213 adult liver transplants using NMP from October 2022 to January 2024. Perfusate lactate levels were measured with an Epoc<sup>®</sup> reader and five lactate-based viability criteria were evaluated for predicting post-LT outcomes. <b>Results</b>: All livers cleared lactate at 6 h of NMP (median 0.51 mmol/L). However, 33 livers failed at least one lactate viability criterion. Thirteen livers (6.1%) were discarded based on traditional criteria, but discard rates would have been higher using Groningen (14.6%) or Brisbane (11.2%) criteria for lactate. Outcomes for the recipients of livers that failed the lactate criteria were comparable to those of recipients with livers meeting all criteria, including biliary complications (<i>p</i> = 0.63), graft survival (>0.99), and 6-month CCI (<i>p</i> = 0.89). ROC analysis revealed poor predictive value for graft survival for lactate clearance criteria (AUC 0.50), while lactate was outperformed by MEAF score (AUC 0.67). <b>Conclusions</b>: Lactate clearance alone does not predict outcomes, highlighting the need for further validation of alternative viability.
Abstract from DOAJ. Public domain (CC0 1.0).
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Panconesi, R., Satish, S., Wehrle, C., et al. (2026). Assessing Lactate’s Role as a Predictor of Post-Transplant Outcomes During Normothermic Machine Perfusion. Livers. https://doi.org/10.3390/livers6040067